Understanding Joint Bleeding in Hemophilia

Kids with hemophilia commonly experience musculoskeletal bleeding. While prophylactic medications can help prevent bleeding, they don’t prevent the joint damage that comes along with it. While working to understand this type of bleeding and treatment options better, hematologist/oncologist Beth Warren, MD, recognized a gap in the research: movement.

“Logically if you have a musculoskeletal bleed, there should be a force involved in starting it,” she says. “And for example, we saw that kids who play basketball actually don’t seem to do worse than kids who don’t play basketball. But is there something different about their movement patterns?”

With the encouragement of her pediatric hematology mentor, Marilyn Manco-Johnson, MD, Dr. Warren connected with research mentor James Carollo, PhD, and successfully applied for a National Institutes of Health K23 grant, which is designed to provide an intensive, supervised, patient-oriented research experience.

The pilot study compared movement patterns between children with severe joint damage from hemophilia and children without hemophilia. The team placed reflective markers on participant’s bodies to track them as they went through a series of simulated sports movements that included squats, single-leg hops, treadmill running and more.

So far, the team has noticed significant differences in movement patterns between their two study populations. For example, kids with hemophilia tended to squat less deep and had lower knee flexion.

“We’re seeing some differences in the forces that are being generated, and we’re seeing some limitations imposed by the joint bleeding that’s showing up in some of these differences,” Dr. Carollo explains.

Whether those differences are adaptive and help stop bleeding or are creating more bleeding is still unknown. The team plans to conduct future research to understand this relationship better. Either way, gaining this new understanding will certainly help improve treatment options, and fast.

“No one in the hemophilia world has really taken a motion- analysis approach to being able to understand what causes these bleeds, what is dangerous for the bleeds and what is the long-term outcome if you keep bleeding,” Dr. Warren says. “Treatments for hemophilia are getting better and better, and that is causing kids to want to do more and more. I think what we learn from this is going to help us figure out how to prevent injury.”